Personality disorders Flashcards
What are the factors in the Five-factor model?
Openness Conscientiousness Extraversion Agreeableness Neuroticism
ICD 10 says that the enduring patterns of inner experience and behaviour seen in personality disorder must manifest more than 1 of which areas?
cognition (ways of interpreting self & others)
affectivity (range, intensity & appropriateness of emotional response)
interpersonal functioning
impulse control
Are personality disorders triggered by certain stimuli or situations?
No they have to be pervasive, inflexible, maladaptive or dysfunctional across a broad range of personal and social situations.
Anankastic personality disorder is characterised by what?
Feelings of excessive doubt and caution.
Preoccupation with details, rules, lists, order, organisation etc.
Perfectionism that interferes with task completion.
Rigidity & stubbornness.
What is the difference between a trait and a disorder?
It is a disorder only if it is pervasive, causes distress ± causes impairment of functioning in most areas.
Which personality disorders might you see in cluster A of DSM-V?
paranoid
schizoid
schizotypal
“odd and eccentric”
Which personality disorder might you see in cluster B of DSM-V?
Antisocial/Dissocial
Emotionally unstable (impulsive or borderline)
Histrionic
(Narcissistic - not in ICD-10)
“dramatic and emotional”
Which personality disorders might you see in cluster C of DSM-V?
Anxious (Avoidant)
Dependent
Anankastic
“Anxious and avoidant”
Paranoid personality disorder has which characteristics?
4 of: Excessive sensitivity to setbacks Tends to bear grudges Recurrent suspicions Persistent self-referential attitude associated particularly with excessive self-importance. Preoccupied with conspiracies.
What features might you see in schizoid PD?
4 of: Emotional coldness / flattened affect. Few if any activities provide pleasure. Indifferent to praise or criticism of others. Little interest in sex. Choses solitary activities. No close friends/relationships. Insensitive to prevailing social norms.
What features might you see in schizotypal PD?
5 or more of: Ideas of reference Odd beliefs/magical thinking Odd thinking and speech. Suspicious Inappropriate affect Behaviour and appearance that is odd, eccentric or peculiar. Lack of close friends. Excessive social anxiety that doesn't diminish with familiarity.
Which features might you see in antisocial PD?
3 of:
callous unconcern for feelings of others.
Disregard for social norms (e.g. burglary)
Incapable of maintaining enduring relationships (no problem establishing them)
Easily frustrated / aggressive
Unable to feel guilty
Often blames others.
What features might you see in the Impulsive variant of emotionally unstable PD?
3 of:
unexpected acts with no regard for consequences
quarrelsome behaviour
liable to outburst of anger/violence
unstable mood
difficulty completing a task if offers no immediate reward
What features might you see in the borderline variant of emotionally unstable PD?
Disturbances in/uncertainty about self-image, aims & internal preferences. Intense & unstable relationships Excessive efforts to avoid abandonment Recurrent threats/acts of self-harm. Chronic feelings of emptiness
What features might you see in histrionic PD?
self-dramatisation / exaggerated emotions
shallow affect
likes to be centre of attention
inappropriately seductive
overly concerned with physical attractiveness.
What features might you see in Narcissistic PD?
Fixed fantasises of infinite success, control, beauty, brilliance etc.
Belief that they are extraordinary/exceptional and can only be understood by similar people.
Sense of entitlement
Wants unwarranted admiration.
No form of empathy
Resentment of others
Egotistical and conceited behaviours / attitudes.
What features might you see in anxious PD?
Belief that they are socially inept/inferior to others.
Excessive worrying about being criticised/rejected in social situations.
Unwilling to get involved with people unless certain of being liked.
Restrictions in lifestyle due to need for security.
Avoiding social activities that involve interpersonal contact due to fear of criticism.
What features might you see in dependent PD?
Allowing others to make their important life decisions.
Subordination of their own needs to those on which they are dependent.
Won’t make even reasonable demands of dependents.
Feels uncomfortable / helpless when alone due to fears of inability to care for themselves.
Unable to make everyday decisions without lots of advice/ reassurance.
Which personality disorders may improve with the use of low dose antipsychotic drugs?
All 3 cluster A disorders - reduce suspiciousness.
Borderline PD - if patient is paranoid or hearing voices.
In which PD might an antidepressant be useful?
Cluster B disorders - helps with mood and emotional difficulties.
Borderline line & antisocial - some SSRIs can help reduce impulsiveness and aggression.
Cluster C disorders - reduce anxiety.
In which PDs might mood stabilisers be useful?
Borderline disorder - help with unstable mood and impulsivity.
What would be the 1st line drug to help with affective dysregulation?
SSRI or mirtazepine
What would be the 1st line to help with difficulties with impulse control?
SSRI
then olanzapine
What is the mainstay treatment for emotionally unstable PD?
Dialectical Behavioural Therapy (DBT)
